Viewpoint - Local councils don't commission

Mental health and learning disabilities services pose challenges for GP consortia.

Mr Hallows: dramatic cost rises (Photograph: Lindsay Ephgrave)
Mr Hallows: dramatic cost rises (Photograph: Lindsay Ephgrave)

GP consortia will soon become responsible for commissioning mental health and learning disability services and the budgets underpinning them.

These range from supported living models through residential care (with and without nursing care) to independent hospital placements.

Take nothing for granted
Systems exist within health and social care bodies to manage the placement of individuals within these services.

So consortia could be forgiven for assuming the existence of these systems with clinically grounded management teams means that they can breathe a sigh of relief: nothing to do there other than sit back and let the system continue to do what it does.

But there are several notes of caution that should be sounded:

  • It would be wrong to assume that the existing teams actually commission services. In the vast majority of situations they do not. What they do is purchase placements for individuals. The more complex the service provision, the more likely it is that the market is controlled by private sector providers. That does not make for a commercially balanced relationship.
  • Where local commissioning teams are involved in the development of service provision, either through in-house arrangements or in association with private or voluntary sector providers, this is in most cases clinician-led - clinical teams have many admirable qualities, but business skills are not among them and the budget holder has to live with the consequences.
  • Many contractual arrangements within this sector are spot purchased. Rarely do you find a contractual arrangement covering the need to deliver measurable outcomes (clinical or commercial). Contracts on their own are meaningless, but what the absence of such focus demonstrates is that outcomes are not in the minds of the contracting parties.
  • Control over placements once made is very limited. Prices can rise dramatically overnight. For example, a placement in an independent hospital may have been made at £2,900 per week. Deterioration in the patient's mental health will often be 'managed' through increased staffing levels. A rise to more than £4,000 per week is reasonably likely.

These are just a few major points, but what should concern consortia managers is that this is a market which is not controlled by commissioning teams. The lack of commercial focus within the purchaser arm has led to an imbalance of power within existing and new relationships.

GP consortia would be well advised to properly vet what they will be picking up at handover, and ensure that the teams and systems which they have in place will deliver measurable outcomes.

  • Graham Hallows is chief executive of Commercial and Clinical Solutions Ltd, a health and social care partner organisation that works with NHS trusts and local authorities to make services more cost effective,
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